Moscow: Long lambasted for brutally crushing dissent, Uzbekistan's President Islam Karimov has kept a stranglehold on power for over 25 years — even at the expense of his own daughter.

The veteran leader, 78, in a critical condition after suffering a stroke, has played Russia, the West and China off against one other to avoid total isolation after steering his strategic state out of the collapse of the Soviet Union.

"Islam Karimov has been the state for over quarter of a century, ruling with an iron fist," Steve Swerdlow, Central Asia researcher for Human Rights Watch, told AFP.

"The last 25 years have been known largely for repression — that's his legacy."

His authoritarian rule has come under fire for alleged rights abuses, most prominently over bloodshed in the city of Andijan in 2005, but the most serious threat to his reign appears to have come from far closer to home.

Islam Karimov. Image Courtesy: Kremlim.ru

In a court drama with echoes of Shakespeare, the former Soviet apparatchik -- at the helm since 1989 — reportedly had his eldest daughter put under house arrest in 2014 during a family feud in which she compared him to brutal Soviet leader Joseph Stalin.

The spectacular fall from grace of Gulnara Karimova — a pop-singing, corruption-tainted socialite once seen as a possible heir to her father's throne -- appeared to show just how far Karimov was willing to go to keep his iron grip on power.

Karimov, long the subject of rumours about his ill health, has no obvious successor in a country that has never held an election judged free and fair by international monitors.

He won Uzbekistan's first elections after the fall of the Soviet Union in 1991 and last March cruised to his fifth five-year term with over 90 percent of the vote.

"Without a strong government there will be chaos in society," Karimov warned ahead of the poll.

'Sorcery'

Born on 30 January, 1938, Karimov was raised in an orphanage in the ancient city of Samarkand. He studied engineering and rose up the Communist Party ladder to become head of Soviet Uzbekistan in 1989.

Like the authoritarian leader of neighbouring Kazakhstan, Nursultan Nazarbayev, Karimov led his country through the transition from the former USSR without any major tests to his rule.

Critics, however, say he squandered the potential of his cotton-rich nation of 30 million — the most populous in ex-Soviet Central Asia -- and allowed elite corruption to flourish.

The major challenge for Karimov came when the palace power struggle within his own family emerged in 2013.

The reported arrest of the once-untouchable Gulnara Karimova, 44, came after a war of words played out in the international media during which she accused her mother and younger sister of sorcery, and assailed the country's security chief on Twitter for harbouring presidential ambitions.

She has since been kept under house arrest as prosecutors probe her and business associates over connections to a "criminal gang".

Formerly a fixture at Western fashion events, Karimova is also under investigation in Europe over a $300 million (276 million euros) telecoms corruption scandal.

'Hundreds killed'

After the majority Muslim republic gained independence in 1991, Karimov launched simultaneous battles against Western culture and Islamic fundamentalism, which was viewed as a major threat.

Right groups have repeatedly accused his regime of torturing opponents and using forced labour in the lucrative cotton sector.

The authorities have consistently denied the allegations -- including the notorious claim that two alleged extremists were boiled alive in 2002.

The most persistent accusations from rights activists remain that government forces killed hundreds of demonstrators in the eastern city of Andijan on May 13, 2005.

The government dismissed the reports of a massacre and said the violence was a response to Islamic extremism.

Although there was no independent investigation of the killings, which followed the arrest and subsequent jailbreak of a group of religious businessmen, an OSCE report estimated the death toll at between 300-500 people.

But over a decade on, Uzbekistan still receives aid from the United States and both Secretary of State John Kerry and Russian leader Vladimir Putin have jetted in for talks over the past year as their countries continue to vie for influence, much to the chagrin of rights activists.